Unmasking Racial, Ethnic, and Socioeconomic Disparities in United States Chordoma Clinical Trials: Systematic Review
by
, , ,
Ali Haider Bangash
1
,
Jessica Ryvlin
1, 
Vikram Chakravarthy
2,
Oluwaseun O. Akinduro
3,
Patricia L. Zadnik Sullivan
4,
Tianyi Niu
4,
Michael A. Galgano
5
,
John H. Shin
6,
Ziya L. Gokaslan
4,
Mitchell S. Fourman
1,7
,
Yaroslav Gelfand
1,8,
Saikiran G. Murthy
1,8,
Reza Yassari
1,8 and
Rafael De la Garza Ramos
1,8,* 1
Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
2
Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
3
Department of Neurosurgery, Mayo Clinic, Jacksonville, FL 32224, USA
4
Department of Neurosurgery, Brown University, Providence, RI 02912, USA
5
Department of Neurosurgery, University of North Carolina, Chapel Hill, NC 27599, USA
6
Department of Neurosurgery, Harvard Medical School, Boston, MA 02115, USA
7
Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
8
Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(2), 225; https://doi.org/10.3390/cancers17020225
Submission received: 21 November 2024
/
Revised: 27 December 2024
/
Accepted: 9 January 2025
/
Published: 12 January 2025
(This article belongs to the Section Cancer Survivorship and Quality of Life)
Simple Summary
Chordoma is an aggressive bone cancer that is hard to treat. To find better treatments, we need clinical trials that are inclusive to all patients. Our research looked at chordoma trials in the United States to see whether they include people from different racial, ethnic, and economic backgrounds. We found that minorities were significantly underrepresented in these trials, and information about patients’ socioeconomic status was altogether missing. This lack of diversity could mean that treatments are not being tested on all the groups they need to help. Our findings highlight the need for more inclusive chordoma research. By improving diversity in clinical trials, we can work towards better treatments and outcomes for all patients with chordoma, regardless of their background.
Abstract
Background: Chordoma is a rare bone cancer with limited treatment options. Clinical trials are crucial for developing effective therapies, but their success depends on including diverse patient populations. The objective of this study was to systematically evaluate the reporting of racial, ethnic, and socioeconomic diversity in United States clinical trials exploring treatment for chordoma. Methods: A literature search was conducted through PubMed/Medline, Cochrane, Epistemonikos, and ClinicalTrials.gov databases for published US chordoma trials up until 19 August 2024. The data collected included trial characteristics and racial and ethnic data, as well as socioeconomic indicators when available. Methodological Index for Non-Randomized Studies (MINORS) and Revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB2) analyses were adopted to assess the methodological quality. The N-1 Chi-squared (χ2) test was implemented to compare the reported racial and ethnic data with the most recent US Census Bureau data. Results: Five trials involving 111 patients (median age: 63 years; 34% female) were included. Four studies (80%) were single-arm non-randomized studies with one study (25%) having a high methodological quality and three (75%) having a moderate quality based on the MINORS analysis. Most patients (91%, n = 82) were White/Caucasian, representing a proportion which was significantly higher than the reported 75% in the US population (p = 0.0005). Black/African American patients (2%, n = 2) were significantly underrepresented compared to the 14% in the US population (p = 0.0015). Regarding ethnicity, Hispanic/Latino patients (7%, n = 6) were significantly underrepresented compared to the 20% in the US population (p = 0.0021). No measures of socioeconomic status were reported. Conclusions: This systematic review highlighted the need for improved racial and ethnic diversity in chordoma trials and the better reporting of socioeconomic data. The underrepresentation of minority groups may obscure potential disparities in disease incidence, treatment access, and clinical outcomes.
Keywords:
chordoma; diversity; race; socioeconomic status; insurance; employment; vulnerability
